The saying “What you donʼt know canʼt hurt you” clearly does not apply to the problems consumers face in getting high quality health care. Yet, consumers have been slow to use comparative performance reports to help them make health care choices. About 19% of consumers said they saw and used quality information in their decisions in 2004, up from 12% in 2000.1 It’s surprising that people have little interest in information that could help them avoid injury and death. The answer to this apparent enigma can be found in three inter-related areas: 

• The invisibility of the quality gap; 

• Consumer concepts of quality; and

• Challenges faced in making choices using comparative performance information.